IVF-ET Outcome And Cost-effectiveness In Patients With Polycystic Ovarian Syndrome

Objective:The aim of this research is to compare the treatment and pregnancy outcomes of polycystic ovary syndrome(PCOS)patients with tubal factor infertility patients(normal ovarian responsible)after in vitro fertilization/intracytoplasmic sperm injection-embryo transfer(IVF/ICSI-ET). At the same time,comparing the cost-effectiveness of different types of follicular stimulating hormone(FSH) during the controlled ovarian hyperstimulation(COH) for the PCOS patients in vitro IVF/ICSI-ET. Methods: Part 1The data wered analysised from Reproductive Center of The Third Affiliated Hospital of Zhengzhou University between February 2009 and December 2014 that included patients with IVF. Exclusive criterias:(1) Women with chromosomal abnormalities,endometriosis,hypothyroidism,history ofovary surgery,et a1;Male with abnormal semen et a1.PCOS was diagnosed by Rotterdam criteria.Selecte the tubal controls by age, years of infertility and BMl with 1 to 4 compared to PCOS women.330 PCOS and 1336 tubal controls patients were selected.Data including duration of down-regulation.dose of gonadotropin(Gn) and follicle stimulating hormone(FSH), the cost of COH. The level of serum E2,P on the day of HCG injuction,endometrial thickness, the number of oocytes retrieved,the rate of high quality embryo,fertilization and clinical pregnancy;miscarriage and live birth rate;the rate of small for gestational age infant(SGA) and lage for gestational age infant(LGA); the incidence rate of OHSS were compared. Part 2The clinical indexes of 312 cycles of the cases who received IVF/ICSI-ET for the first time in the hospital from February 2009 to December 2014 were analyzed retrospectively.They were divided into three groups according to types of FSH used during the COH: urinary FSH(r FSH) group(n=57),highly purified urinary FSH(FSH-HP,Fostimon) group(n=55) and recombinant FSH(r FSH,Gonal-F) group(n=200).Times of using FSH,doses and charges of FSH, the numbers of oocytes,fertilization and good embryo rate,clinical pregnancy rate,miscarriage rate and cost-effectiveness ratio(CER) were compared among different groups. Results: Part 1The level of serum b LH of PCOS were higher than that of tubal controls.The amount of Gn and FSH of PCOS were decreased(P<0.05). But the duration of Gn used in the PCOS group was longer(P<0.05). The concertration of serum E2 on the day of HCG injection,the numbers of oocytes retrieved were significantly higher in the PCOS group(P<0.05). Then incidence of OHSS was increased(P<0.05).The fertilization rate was lower, but the good-quality embryos and implantation rate had no difference.For PCOS,abortirate was higher(P<0.05). The live birth rate decreased in PCOS group(P<0.05). While overall clinical pregnancy rate and biochemical pregnancy rate were similar, with similar rates of SGA and LGA. Part 2Generally compared,the amount of Gn and FSH of urinary FSH group were higher than that in other groups(P<0.05).The duration of Gn used in urinary FSH group was longer than recombinant FSH group(P<0.05).The fertilization rate,good embryo rate of recombinant FSH group was higher than urinary FSH group(P<0.05).The fertilization rate of highly purified urinary FSH group was also higher than urinary FSH group(P<0.05).The charges of drugs and total cost of highly purified urinary FSH group were higher than that in other groups(P<0.05).The CER of recombinant FSH group is the lowest among the three groups. Conclusion:Firstly,the fertilization rate of PCOS was decreased,however, good-grade embryos and implantation rate were no difference, suggesting that PCOS cause the failure of fertilization. Secondly, PCOS increased the rate of miscarriage and decreased the live birth rate. The result suggested that endocrine disorder in PCOS patients may have adverse effects on pregnancy outcome. Fortunately, PCOS patients through the technology of IVF-ET pregnancy, the ectopic pregnancy rate, premature birth rate, SGA and LGA rate had no difference in lag ratio. Which shows that if the index adjust to normal, then keep pregnancy monitoring and treatment, it can obtain similar neonatal outcomes to healthy pregnant women. And then, when considering the average cost per delivery, recombinant FSH is economically efficient.